A Rare Case of Tetanus With Early Manifestation of Apnea But Without Trismus

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-03-01 DOI:10.1016/j.jemermed.2024.09.023

Tsutomu Yasuda MD, PHD , Yasuhiro Kimura MD , Mizuki Kitamura MD , Takahiro Nakayama MD , Hideo Nishizawa MD , Ichiro Imafuku MD

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引用次数: 0

Abstract

Background

Tetanus is a life-threatening disease caused by tetanus neurotoxin (TeNT) produced by Clostridium tetani. Early symptoms of tetanus are trismus and muscle stiffness, both caused by spasticity. TeNT mainly exerts its effect by impairment of inhibitory neurons in the spine and brainstem, resulting in the hyperactivity of motor neurons, which causes spasticity and muscle spasms. Apnea is not a symptom that is predicted to occur in the early stages.

Case Report

We present a rare case of severe tetanus with an early manifestation of apnea but without trismus. We believe that apnea was caused by spasms of the intercostal muscles and its early manifestation was due to a high load of TeNT, considering that the speed of disease progression is related to disease severity. We hypothesize that the absence of trismus was also due to a high load of TeNT, exerting toxic effect at the neuromuscular junction and causing flaccid paralysis of the masseters.

Why Should an Emergency Physician Be Aware of This?

Since there is no diagnostic laboratory test for tetanus, emergency physicians must be well aware of symptoms that may or may not appear in tetanus. Tetanus should be considered as a differential diagnosis for patients arriving at the emergency department with apnea as an early symptom. The absence of trismus should not rule out the possibility of tetanus.

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破伤风早期表现为呼吸暂停，但无紧张症1例。

背景：破伤风是由破伤风梭菌产生的破伤风神经毒素引起的一种危及生命的疾病。破伤风的早期症状是紧张症和肌肉僵硬，两者都是由痉挛引起的。TeNT主要通过损害脊柱和脑干的抑制性神经元来发挥作用，导致运动神经元过度活跃，引起痉挛和肌肉痉挛。呼吸暂停并不是预测在早期阶段就会出现的症状。病例报告：我们提出一个罕见的严重破伤风病例，早期表现为呼吸暂停，但没有咬关。我们认为呼吸暂停是由肋间肌痉挛引起的，考虑到疾病进展的速度与疾病的严重程度有关，其早期表现是由于TeNT的高负荷所致。我们推测，闭锁的缺失也是由于高负荷的TeNT，在神经肌肉连接处发挥毒性作用，导致咬肌弛缓性麻痹。急诊医生为什么要意识到这一点？由于没有诊断破伤风的实验室检查，急诊医生必须充分了解破伤风可能出现或不出现的症状。对于以呼吸暂停为早期症状到达急诊科的患者，破伤风应被视为鉴别诊断。没有牙关不应排除破伤风的可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine